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General NPI Number Information
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NPI Number | 1932545209
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Entity Type | Individual
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Provider Name | DEIRDRE WILSON MSW, IC-1758
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Gender | Female
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 2980 S RAINBOW BLVD # 200E
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City | LAS VEGAS
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State | NV
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Zip | 89146-6531
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Country | US
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Telephone | 702-673-7462
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Fax |
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Provider Business Mailing Address
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Address Line | 698 S RACETRACK RD UNIT 922
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City | HENDERSON
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State | NV
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Zip | 89015-8591
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Country | US
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Telephone | 408-386-8955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | IC-1758
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1523P-S
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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